3335 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No. " (Complete in Duplicate) � Date Issued k Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB.ADDRESS AND LOCATION---- _ -.,�fl. -- 71------------------- Owner's Name---------------•----------•---------- Gl. �-----('----CC( 107-1 A -=---- ----------------- Phone---,J-A---7-7 1 Address--..............-------------------------------- ------__ ---- ---------------------------------------------•------- ------------- Contractor's,.Name--------------------------------. •--- I . . Q.!? ------. Phone . = Installation will serve: Residence [�( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _A--- Number of bedrooms _ Number of baths J_-_ Lot size ----------------------------------------- ----------------- s Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [I Clay Loam ❑ Clay ❑ Adobe, Hardpan ❑ Previous Application Made: Yes (] No ❑ New Construction: Yes ❑ No ❑ TYPE =0F INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - - '4 Septic Tank: Distance from nearest well___ _-Distance from foundation_-0!.-----_Material-------------------- ------------ ___-. "6 r/� rr , No. of compartments----` -------- 5ize5G----:---�-------__Liquid=depth-- .---------CapacitY��1 3r T mc.:-cam f �," Disposal Field: Distance from nearest well__,___________-_Distanceirom foundation- --------------Distance to nearest lot line---------------_. ,r Number of lines-------------s-..-------- ------Length of each,line------------------------------Width of trench----------------------------------- ., Type of filter material--------------------------Depth of filter material----------------------Total length------------------------------------------ W --------�---^--------- ,,44 ` __ '' f QY� Distance to nearest lot line--tel-__ _. Seepage Pit: Distance to nearest wsll-.C' -4� -:Distance f,"'�qm�f°°��ndat�on.. ............... .� Number of pits------f--------------Lining material d `r�► .__.Size: Diameter-4-,3_.__._-___.Depth.___s�..�f-_.------,--- Cesspool: Distance from nearest well---`-------------Distance from foundation--------------------Lining material---------------------------_--------- V ❑ Size: Diameter--- ------------- `-- ----- Depth-----------=- ------ -"- -----Liquid Capacity----------------------------gals. '. Privy: Distance from nearest well-------•- ---------- --------------- ...Distance from nearest building---.-.--_-.__.--------.-_---__.__-____._.. ; [� Distance to nearest lot line---------------------------------------------------------------------- ----- Y Remodeling and/or repairing (describe)=------------------------------------------------------------------------------------------------ ---------------------------------•---------------------- a r I hereby certify at have prepared this application and that the work will be done'' y It in accordance with San Joaquin Coun ordinances, S#ate�laT An rules and regulations of the San Joaquin Local Health District. �O (Signed)...:-•---......-•--- -------------- ------------ - ----------------------- --- --•--- -------/K------------•-------- --- (Ow and/or Contractor) BY= LTi#IeJ- lr1�u --------------------- ----------------------------------•----------------------------------------- ------• -- (Plot plan, showing size of lot, location of system in relaf*,/ o wells, buildings etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- •� -� DATE. -- ---- ------- ----------------------------- -------------------------------------------- REVIEWED BY----------•------------------------- -------------- DATE BUILDING TD - - ---------------•------•------------------------•---. DATE-- ------mo i -------------------------------------- Alterations ----- ----- ------ - --------- Altera#ons and/or ------------------ --- -- --------------- ------••---•------------------------ ----- -----------•------------•-•-----•- - 3 --------------------------------------------------------- _ _ _ .--. -_--_ _ ______-._-__--.- FINAL INSPECTION BY-1-az------------------ � --------- Date----`_- _`- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street. 300 West Oak Street 132 Sycamore Street _ 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M IC-52 Revised W.-2100 rs